Direct health care costs associated to neurological diseases and different degrees of malnutrition

Abstract

Background and Aims: Home-based care and oral supplemental nutrition may be an efficient way of managing health resources, freeing up hospital resources and improving patient care and quality of life. For some conditions, such as neurodegenerative diseases and acute neurological conditions, adequate nutritional control of patients at the time of discharge, with home monitoring by a home hospitalization unit (HHU), coupled with the introduction of necessary and appropriate oral nutritional supplements for each patient, is a good strategy for ensuring the efficiency of health resources. The aim of this paper is to analyse the direct health costs, considering home care and oral nutritional supplement, of patients with newly diagnosed neurological diseases and at risk of nutritional problems. Methods: A study was designed to measure direct health care costs of patients with neurological related diseases according to their different nutritional needs. The sample for this study consisted of all patients (n=100) of the Elda University Hospital in Elda, Spain, with newly diagnosed neurological pathology and suspected malnutrition at hospital discharge during a six months period. These patients were included in a home base care program and given oral nutritional supplements afterwards. The nutritional intervention consisted in giving nutritional supplements according to nutritional patients’ needs through a home-based care unit. Nutritional needs could comprise from protein-calorie malnutrition to at risk of malnutrition. Descriptive health care costs analysis was carried out accounting for the nutritional status. Costs are expressed in 2018 euros and for a total time horizon of one year, six months of classical inpatient care and six months of home care monitoring with a nutritional intervention. Results: Mean direct health care cost for neurological patients in the six months of classical inpatient care was €8,309.30 and, the direct healthcare cost of treating these patients according to their nutritional needs from a home care unit was €2,970.18. The subgroup of patients that most benefited from the nutritional intervention and monitoring from the home care unit were those who were in a state of protein-calorie malnutrition or at risk of malnutrition. Under the log transformation of the variables, the Shapiro-Wilk test showed significant differences in mean costs at the 5% level for the two time periods for those suffering from protein-calorie malnutrition or at risk of malnutrition. Conclusions: It is important to measure and economically quantify the direct health care costs of patients with neurological diseases in order to be able to evaluate different hospital and home-care interventions according to different nutritional needs. Oral nutritional supplements and monitoring by the hospital home care unit could be associated with saving money when patients have protein-calorie malnutrition or at risk of malnutrition. Therefore, direct health costs information is needed to future evaluate these different management interventions.